Risks and Benefits of Estrogen Therapy for a Male-to-Female Transsexual with a Prothrombin Gene Mutation |
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| Institution: | 1. School of Medicine and Health Sciences, George Washington University, Washington DC;2. Center for Andrology and Division of Endocrinology, George Washington University, Washington DC.;1. Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey;2. Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;3. Department of Pathology, Jersey Shore University Medical Center, Neptune, New Jersey;4. Department of Endocrinology, Jersey Shore University Medical Center, Neptune, New Jersey;5. Shore Endocrinology Associates, Pt. Pleasant, New Jersey;6. Southern Ocean Medical Center, Manahawkin, New Jersey;7. Atlantic Hematology Oncology, Manasquan, New Jersey;8. Hereditary Cancer Risk Program, Meridian Health System, Neptune, New Jersey.;1. UAB School of Medicine, University of Alabama at Birmingham;2. Center for Clinical and Translational Sciences, University of Alabama at Birmingham;3. Department of Pediatrics/Division of Pediatric Endocrinology and Metabolism, Children’s of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.;1. Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.;2. Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California.;1. Tytgat Institute for Liver and Intestinal Research, Academic Medical Center (AMC), Amsterdam, The Netherlands;2. Department of Gastroenterology, University Hospital Leuven, KU Leuven, Leuven, Belgium;1. Andrology, Women''s Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy;2. Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy;3. Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy;4. Department of Experimental and Clinical Biomedical Sciences \"Mario Serio\", University of Florence, Florence, Italy;5. Department of Endocrinology, Oslo University Hospital, Oslo, Norway;6. Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands;7. Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium |
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| Abstract: | ObjectiveWe present the case of a male-to-female transsexual person in her 20s requesting hormone therapy in the setting of a history of a deep venous thrombosis and pulmonary embolus and carrying the prothrombin G20210A gene mutation.MethodsWe interviewed the patient and reviewed her medical records. We carefully weighed the risks and benefits of hormone therapy and took into account two important ethical principles: beneficence (to act in the patient’s best interest) and nonmaleficence (to avoid harm).ResultsOur patient presented to an outside facility with weight loss, generalized weakness, right lower extremity swelling, and chest pain. She was diagnosed with a pulmonary embolus and extensive deep venous thrombus by computed tomography (CT) scan and Doppler ultrasound, respectively. She was found to carry the pro-thrombin G20210A gene mutation. She was treated with anticoagulation therapy for 12 months, which was restarted prior to beginning therapy with transdermal estrogen.ConclusionWhile the exact risk of recurrent deep venous thrombosis and pulmonary embolus in our patient is unknown, we recommended that hormone therapy should only be given in conjunction with anticoagulation. We speculate that this strategy would allow the patient to experience the benefits to her overall well-being with hormone therapy while reducing the risks of venous thrombosis to acceptable levels. Prospective long-term follow-up of this patient is needed to verify the benefits and risk of the intervention chosen. (Endocr. Pract. 2013;19:e150-e153) |
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